HRT

Question 1

Which of the following is a CI for starting HRT
Previous hx of DVT
Age over 55 years
Mild hot flushes
Post hysterectomy

Answer 1

Previous hx of DVT
Unless on anticoagulant.

Question 2

Which of the following routes of HRT is considered to have the lowest risk of VTE
Oral tabs
Transdermal patches
Vaginal pessaries
Implants

Answer 2

Transdermal

Question 3

A 50 year old woman with a hx of breast cancer asks about HRT for managing menopausal symptoms which of the following is the most appropriate course of action
- Prescribe combined HRT, as it is suitable for women in early menopause
- Advise against HRT and recommend non hormonal treatments for symptom management
- Offer transdermal oestrogen only
- Prescribe HRT with a low dose oral progestogen

Answer 3

Advise against HRT and recommend non hormonal such as lifestyle (diet, exercise, herbal supplements, cognitive behavioural therapy)

Question 4

A 51 year old woman presents with vasomotor symptoms of the menopause including night sweats and hot flushes. She has A BMI OF 34 AND HER LAST PERIOD was 9 months ago

Which is the most appropriate HRT

Continuous combined HRT
Cyclical combined HRT patches
Cyclical combined HRT tablets
Oestrogen only HRT gel
Oestrogen only HRT tabs

Answer 4

Oestrogen only HRT is contraindicated in women with an intact uterus due to the risk of endometrial cancer. Since this woman had her last menstrual period 9 months ago and there is no mention of her having a hysterectomy, this would indicate that she still has an intact uterus. Cyclical HRT is more appropriate than the continuous type as she is within 12 months of her last menstrual period, and the patch form is the preferred formulation due to her risk of VTE related to her obesity.